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Transfusions Deliver Death
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ironjustice
Jan 5, 2013, 10:56:53 AM1/5/13
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"GI Bleeds: Withholding Transfusions Boosts Survival"
"Withholding transfusions until hemoglobin levels are lower than 7%,
rather than 9%, improves overall survival by 45%"
http://www.medscape.com/viewarticle/777187
----------------
On-Scene IV Fluids for Trauma Patients May Be Causing More Harm Than
Good
BALTIMORE, Md -- January 5, 2010 -- Severely injured patients who are
routinely given IV fluids by paramedics before transport to the
nearest trauma centre are significantly more likely to die than
similarly injured patients who don't get the time-consuming IV
treatment before hospitalisation, according to a study published
early
online and appearing in the February 2011 issue of Annals of Surgery.
The study raises new questions about a medical practice developed
decades ago that continues to be the standard of care despite lack of
scientific research into its validity.
The researchers said that mandating pre-hospital IV fluids for all
trauma patients -- the norm in many states -- should be discouraged.
Some groups are slowly considering changes to their guidelines.
"Giving IV fluids to patients before they go to the hospital can
delay
transport," said lead author Elliott R. Haut, MD, Johns Hopkins
University School of Medicine, Baltimore, Maryland. "Our study
suggests it may be better to get patients to the hospital faster.
Starting fluids takes time and the IV fluids may cause harm on top of
the timing issue."
Intravenous fluids are typically given immediately to trauma victims
whose blood pressure has sharply decreased due to blood loss. The
rationale has been that fluids quickly raise dangerously low blood
pressure in order to keep the body's systems working, a concept that
makes intuitive sense, said Dr. Haut. But, there is some evidence
that
IV fluids may actually be making matters worse in those patients in
whom very low blood pressure temporarily stops bleeding. Rapidly
raising blood pressure in these individuals could "pop the clot,"
causing them to start bleeding again before they can get definitive
care in the hospital.
For the study, Dr. Haut and colleagues examined data from 776,734
trauma patients in the American College of Surgeons' National Trauma
Data Bank between 2001 and 2005. The patients were primarily male,
white, and aged younger than 40 years. About half were given IV
fluids
at the scene.
Patients who received pre-hospital fluids were 11% more likely to die
than those who did not. The findings were especially marked in people
who were shot or stabbed (25% more likely to die), had severe head
injuries (35% more likely), and got emergency surgery once
hospitalised (35% more likely).
Emergency medical personnel are required in many states to perform a
variety of interventions before transporting patients to the
hospital.
Each step takes precious time, Dr. Haut noted, and in some cases, the
time it takes to place an IV may exceed the length of the trip to the
emergency room.
"Most people know about the Golden Hour -- the time after an injury
when there is the highest likelihood for survival if patients receive
prompt medical treatment," said Dr. Haut. "But for some people it may
be the Golden 20 minutes and in others 10 minutes can make the
difference between life and death. Many things can be fixed if you
get
patients to the hospital in time, but it's hard to change people's
practices when the change means doing less."
Dr. Haut emphasised that IV fluids may be beneficial in some cases
and
that more research is needed to determine their value in patients
with
traumatic brain injury (TBI), for example. Even though these patients
had worse outcomes with IV fluids in the new study, Dr. Haut said,
previous experience has shown that episodes of low blood pressure can
be very harmful for TBI patients and withholding fluids could lead to
worse outcomes.
SOURCE: Johns Hopkins University School of Medicine
Who loves ya.
Tom
Jesus Was A Vegetarian!
http://tinyurl.com/634q5a
Man Is A Herbivore!
http://tinyurl.com/4rq595
DEAD PEOPLE WALKING
http://tinyurl.com/zk9fk
"Withholding transfusions until hemoglobin levels are lower than 7%,
rather than 9%, improves overall survival by 45%"
http://www.medscape.com/viewarticle/777187
----------------
On-Scene IV Fluids for Trauma Patients May Be Causing More Harm Than
Good
BALTIMORE, Md -- January 5, 2010 -- Severely injured patients who are
routinely given IV fluids by paramedics before transport to the
nearest trauma centre are significantly more likely to die than
similarly injured patients who don't get the time-consuming IV
treatment before hospitalisation, according to a study published
early
online and appearing in the February 2011 issue of Annals of Surgery.
The study raises new questions about a medical practice developed
decades ago that continues to be the standard of care despite lack of
scientific research into its validity.
The researchers said that mandating pre-hospital IV fluids for all
trauma patients -- the norm in many states -- should be discouraged.
Some groups are slowly considering changes to their guidelines.
"Giving IV fluids to patients before they go to the hospital can
delay
transport," said lead author Elliott R. Haut, MD, Johns Hopkins
University School of Medicine, Baltimore, Maryland. "Our study
suggests it may be better to get patients to the hospital faster.
Starting fluids takes time and the IV fluids may cause harm on top of
the timing issue."
Intravenous fluids are typically given immediately to trauma victims
whose blood pressure has sharply decreased due to blood loss. The
rationale has been that fluids quickly raise dangerously low blood
pressure in order to keep the body's systems working, a concept that
makes intuitive sense, said Dr. Haut. But, there is some evidence
that
IV fluids may actually be making matters worse in those patients in
whom very low blood pressure temporarily stops bleeding. Rapidly
raising blood pressure in these individuals could "pop the clot,"
causing them to start bleeding again before they can get definitive
care in the hospital.
For the study, Dr. Haut and colleagues examined data from 776,734
trauma patients in the American College of Surgeons' National Trauma
Data Bank between 2001 and 2005. The patients were primarily male,
white, and aged younger than 40 years. About half were given IV
fluids
at the scene.
Patients who received pre-hospital fluids were 11% more likely to die
than those who did not. The findings were especially marked in people
who were shot or stabbed (25% more likely to die), had severe head
injuries (35% more likely), and got emergency surgery once
hospitalised (35% more likely).
Emergency medical personnel are required in many states to perform a
variety of interventions before transporting patients to the
hospital.
Each step takes precious time, Dr. Haut noted, and in some cases, the
time it takes to place an IV may exceed the length of the trip to the
emergency room.
"Most people know about the Golden Hour -- the time after an injury
when there is the highest likelihood for survival if patients receive
prompt medical treatment," said Dr. Haut. "But for some people it may
be the Golden 20 minutes and in others 10 minutes can make the
difference between life and death. Many things can be fixed if you
get
patients to the hospital in time, but it's hard to change people's
practices when the change means doing less."
Dr. Haut emphasised that IV fluids may be beneficial in some cases
and
that more research is needed to determine their value in patients
with
traumatic brain injury (TBI), for example. Even though these patients
had worse outcomes with IV fluids in the new study, Dr. Haut said,
previous experience has shown that episodes of low blood pressure can
be very harmful for TBI patients and withholding fluids could lead to
worse outcomes.
SOURCE: Johns Hopkins University School of Medicine
Who loves ya.
Tom
Jesus Was A Vegetarian!
http://tinyurl.com/634q5a
Man Is A Herbivore!
http://tinyurl.com/4rq595
DEAD PEOPLE WALKING
http://tinyurl.com/zk9fk
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